Neurosurgeon Hoon Choi, MD, is the director of spine surgery at The Medical College of Wisconsin Green Bay, and an assistant professor of neurosurgery in the department of neurosurgery at The Medical College of Wisconsin in Milwaukee. Dr. Choi has a background in mechanical engineering and performs robotic-assisted surgery.

Question: In addition to your neurosurgery training, you have a master of science degree in mechanical engineering from the State University of New York at Buffalo. How does your background as a neurosurgeon and an engineer guide your work?

Dr. Hoon Choi: I deliberately went into mechanical engineering later on during training, as a resident. In medical school and residency, we generally do not learn about biomaterials and biomechanics in depth, but these are deeply relevant to spine surgery.

Consider that radiologists and radiation oncologists study radiation physics. Spine surgeons should have a basic understanding of biomaterials and biomechanics. There is increasing evidence that patient-reported outcomes are related to sagittal balance and spine biomechanics.

Engineering is very relevant to cranial surgery too. I studied the hemodynamics in cerebral aneurysm formation and rupture. I also studied biomaterial characteristics, such as surface modification and hemocompatibility, for endovascular devices.

One of my goals is to have seamless translational research between neurosurgery and engineering. One example would be to use patient-specific computational modeling to analyze biomechanics, plan surgery and anticipate surgical outcomes.

Q: What opportunities for collaboration between neurosurgeons and engineers do you see?

HC: I see opportunities for collaboration in the preoperative, intraoperative and postoperative spheres. Preoperatively, we can use available technology to plan out surgeries using 3-D modeling. We can simulate different types of surgery and use that knowledge to educate the patient and come up with right intervention. It is possible to model the spine, simulate different dynamic loading cycles and anticipate the future progressions.

Intraoperatively, engineering can make surgery safer and more precise. With robotics, navigation and intraoperative CT, surgery is becoming more accurate. Virtual and augmented reality can be used for patient education and surgical planning preoperatively and to aid surgery intraoperatively. 3-D digital exoscopes can aid with stereoscopic visualization of the surgical field for the entire surgical team during surgery. Postoperatively, 3-D models can be used to analyze the biomechanics and to correlate with patient outcomes.

Q: What are the leading trends in robot-assisted spine surgery?

HC: Currently, robotics, navigation and intraoperative imaging are being integrated into one seamless platform. This platform can be accessed preoperatively to plan surgery and anticipate hardware needs. Augmented reality and digital stereoscopic vision will eventually become integrated. We will eventually see neurosurgical master-slave robotic systems, such as the Da Vinci, with multiple articulating arms and remote surgeon control.

The instrumentation aspect of spine surgery, such as pedicle screw placement, may become automated. Technology currently exists to do this. However, the surgeon must be mindful of possible errors and variables to stay vigilant and avoid complications. Delicate work around the neural tissues may remain manual for a long time.

Artificial intelligence will be integrated to complement surgical decision making and operative robotics.

Regardless of the progression of technology, the patient-surgeon relationship is important and vigilance in the operating room should not waver.